Acupuncture

Targets central sensitization & pain modulation. FM is understood as a disorder of pain processing (heightened central sensitization with impaired descending inhibition). Experimental and clinical research shows acupuncture can modulate pain circuits and neurotransmitters (e.g., endogenous opioids), which plausibly reduces hyperalgesia and improves pain thresholds. Wiley Online Library

Clinical guideline context. European League Against Rheumatism (EULAR) management recommendations for FM (the best-known international guideline set) include non-drug therapies such as exercise and acknowledge evidence for acupuncture among complementary options, though recommendations are typically weak/conditional given heterogeneity of trials. Annals of the Rheumatic Diseases

What meta-analyses suggest overall. Cochrane’s review concludes acupuncture is probably better than no acupuncture for pain/stiffness and may enhance the effect of drugs/exercise; adding electrical stimulation (electroacupuncture) improves outcomes versus needling alone. Later systematic reviews echo modest short-term benefits (pain, function, sleep), with mixed durability beyond a few months.

Frequency & duration per session.

• Once weekly, ~20 minutes per session for 9–10 weeks (used in a multicenter RCT in primary care). ResearchGate

• Alternative regimens in other RCTs used 2 sessions/week for 4 weeks (total 8 sessions). Oxford Academic

Course length. Expect 6–10 sessions initially; reassess at 10–12 weeks. Benefits are often greatest at end of treatment and may attenuate over months; a minority maintain improvements to 6–12 months. AAFP

Style & techniques.

• Individualized traditional acupuncture based on TCM pattern diagnosis was superior to sham in a large RCT (needles retained ~20 min, one session/week). ResearchGate

• Electroacupuncture (low-frequency current across needles) tends to outperform manual needling for pain reduction in FM per Cochrane (if available, ask your practitioner). Cochrane

Point selection. Trials used individualized protocols rather than a fixed recipe; typical treatments combine segmental points (e.g., along painful regions/paraspinals) with distal analgesic points. (The RCT showing benefit used a prespecified algorithm; exact point formulas varied by patient.) ResearchGate

Combine with first-line care. Acupuncture in trials was added to usual care (exercise, education, sleep hygiene ± medications). It should be part of a multimodal plan rather than a stand-alone cure. rheumatology.org

Cochrane Review (ongoing updates; core review CD007070).

Finds acupuncture is likely better than no acupuncture for pain/stiffness; electroacupuncture better than manual alone; and acupuncture may enhance the effects of drugs/exercise. Certainty: low to moderate, with heterogeneity and sham-control nuances. Cochrane

Multicenter RCT in primary care (Vas et al., 2016; n=164).

Individualized acupuncture vs sham, 9×20-min weekly sessions: pain decreased 41% vs 27% at 10 weeks (p=0.001); differences persisted at 12 months (−19.9% vs −6.2%); adverse effects mild/infrequent. ResearchGate

Mayo Clinic RCT (Martin et al., 2006; n≈50).

True acupuncture improved global FM symptoms at 1 month post-treatment; benefits diminished by 7 months (short-term efficacy). AAFP+1

Sham-controlled RCTs & biomarker trial.

Additional trials (some positive, some neutral) include sham-controlled designs and one that measured serotonin/substance P shifts with symptom change over 8 sessions in 4 weeks. Overall, results favor modest improvements, especially with adequate dose and electroacupuncture. Oxford Academic+1

Systematic reviews/meta-analyses (2018–2024).

Pooled data generally show small-to-moderate short-term improvements in pain and function versus sham/usual care, with better effects in protocols using electroacupuncture or individualized point selection. Taylor & Francis Online

Guideline stance.

EULAR’s recommendations place strongest emphasis on education/exercise/CBT, with acupuncture considered as an adjunct option where available and acceptable to the patient. Annals of the Rheumatic Diseases